Although most children seen by dentists are well behaved and cooperative, 20-25 percent of all children are sufficiently distressed and disruptive that many practitioners are not willing to provide care for these children, limiting their access to quality oral health care. The problems are even more pronounced in children with autism and related developmental disabilities. This is compounded by the fact that most dental students report little or no preparation in providing care to individuals with disabilities resulting in few dentists treating children with developmental disabilities. This is a particular concern because children with developmental disabilities, who do not have the ability to understand and assume responsibility for or cooperate with preventive oral health practices, are particularly susceptible to oral disease. Despite recent calls for additional nonpharmacological methods of behavior management to address these challenges, there are relatively few well-controlled empirical evaluations of nonpharmacological methods of behavior management for use with children and even fewer well-controlled studies or programs of research targeting children with autism or related developmental disabilities. The purpose of this research project is to address both of these needs: first, to conducted a well-controlled, randomized trial of a promising behavioral management procedure, and second, to extend a program of research that has found this technique to be effective with a small number of difficult children but has never been tested in large numbers of children or in children with disabilities. Participants will be 180 children, 2-8 years of age requiring restorative dental treatment and will include both typically developing children as well as those with autism and related developmental disabilities. Participants in the experimental condition will receive a program of scheduled breaks provided by the dentist, which has been found in preliminary studies to be a potent intervention in highly disruptive young children. Observations of distress behavior as well as ratings of child reactions will provide direct assessment of program benefits while comparison of time spent on behavior management will provide data for a cost-benefit analysis. The investigation extends a program of research dedicated to evaluating nonpharmacological behavior management methods for dentists has the potential to improve access to quality oral health care for all children. PUBLIC HEALTH RELEVANCE: The purpose of this research project is to evaluate a behavior management intervention involving brief scheduled breaks to reduce distress in children undergoing restorative dental treatment. The research accomplishes several important needs by using a well- controlled, randomized trial of a promising behavioral management procedure and then testing its effectiveness with both typically developing children as well as those with autism and related developmental disabilities. In addition, the investigation extends a program of research dedicated to evaluating nonpharmacological behavior management methods for dentists and includes a cost-benefit analysis. Ultimately, if the behavior management procedure proves as effective for large numbers of children as it has in small pilot investigations, it has the potential to improve access to quality oral health care for children.